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Florence Nightingale: A Nursing Leader Ahead of Her Time

Although Florence Nightingale died nearly a century ago, her contributions to modern nursing are felt today. From proper wound care and the sterile conditions of the modern operating room to the current shift from hospital care to outpatient and homehealth care, it all started with an affluent, young, visionary woman named Florence. 

At age 17, Nightingale became interested in nursing. She worked as a volunteer in village schools and among the neighborhood poor in her homeland of England. "Her limited nurses training included a short time with Sisters of Charity of St. Vincent de Paul in Egypt, and a few months at Kaiserswerth (a hospital) in Germany," says Marilyn Klakovich, DNSc, RN, NEA-BC. However, it was her work in military hospitals during the Crimean War that set the stage for her prolific career as a reformer, educator and leader in nursing.

In her role as Superintendent of Nurses and caring for patients in military field hospitals, Nightingale was struck by the appalling conditions and the number of deaths related to infection. "She spurred army reform and improved not only sanitation, but housing and food for British soldiers throughout the empire," says Klakovich. She became the heroine of the Crimean War, which was immortalized in the poem "Charge of the Light Brigade" by Alfred Lord Tennyson, and used her newfound fame to further sanitary reform for the next 40 years, according to Klakovich.

"(Nightingale) is referred to as the founder of modern nursing," says Klakovich. She started the first sectarian school of nursing. Before that, nursing schools were religious in nature or military orders for men. The Nightingale School of Nursing was funded through donations largely from the British soldiers she aided during the war. Nightingale influenced her students to concentrate on more than the tasks nurses perform, but to focus on the total patient—responding to psychological and social aspects as well. And by mentoring her graduates to start other nursing schools, Nightingale's ideas reached a broader audience.

She was also an early researcher. Nightingale "took meticulous notes and was one of the early statisticians on sanitary conditions and mortality rates," says Klakovich. "She used statistics to analyze social conditions and the effectiveness of public policy and then to influence the allocation of resources." 

Nightingale was a prolific writer, authoring texts, journals, reports and more than 200 personal letters to accomplish her goals. Her book, Notes on Nursing: What it is, What it is Not, was used as a nursing textbook for decades. It emphasized her focus on the environmental aspects of nursing—pure air, light, cleanliness, pure water and efficient drainage. "Nursing theorists in just the last few decades have been focusing on the patient environment," says Klakovich. "I once heard a speaker at a convention on this topic say, 'We're still catching up with this lady after all these years.'"

As a female in the 19th century, Nightingale was ahead of her time. She was a visionary who saw the big picture and had a clear sense of purpose. Reading from a personal letter written by Nightingale, as cited by Woodham-Smith (1950), Klakovich says, "As early as 1867, [Nightingale] wrote, 'My view is that the ultimate destination of all nursing is the nursing of the sick in their own homes … but it is no use to talk about the year 2000.' And look at what's been happening over the past two decades, with health care reform shifting from acute inpatient care to outpatient and home care."

In addition, Nightingale knew her own strengths and limitations. She was a master at getting her ideas implemented through other people. "She was politically savvy and knew who to go to to get things accomplished," says Klakovich, "especially to tap strong men to further the causes she identified."

To honor the contribution of nurses in our communities, National Nurses Week is celebrated each year, May 6-12, culminating on Florence Nightingale's birthday. 

Woodham-Smith, C. (1950). Florence Nightingale. London, England. The Reprint Society.